Saturday, September 30, 2017

Insurance providers are reluctant to cover mental illnesses because of the duration and costs of treatment as well as stigma attached to mental disorders.

A doctor at Kashmir's psychiatry hospital in Srinagar, checks the hands of a Kashmiri youth during a counseling session.

An report highlights that 60 million Indians suffer from mental disorders. This is about 6.5% of the country’s population. The World Health Organisation also estimates that around 57 million Indians suffer from depression. A recent survey by the National Institute of Mental Health and Neuro Sciences or NIMHANS in Bengaluru states that 13.7% of the adult population in India suffers from some form of mental illness. And yet, India spends only about 0.04% of its health budget on mental healthcare.

Mental health and healthcare in India come with a set of taboos and stigmas, which is perhaps why mental healthcare insurance has never been a priority for insurance providers.

The new Mental Healthcare Act, 2017, under the right to equality and non discrimination, states that: “Every insurer shall make provision for medical insurance for treatment of mental illness on the same basis as is available for treatment of physical illness.”

This provision effectively makes it mandatory for all providers of insurance in India to have certain policies and provisions in place that also account for mental illnesses. It also imposes that such provisions must be at par to those for physical illnesses. Considering the placement of this clause, non adherence to it would amount to discrimination.

However, India currently does not have any distinct insurance coverage for mental health disorders even though several health policies may cover mental illnesses briefly or under other conditions.

Need for mental healthcare insurance
Mental healthcare insurance provides coverage for mental treatment and care expenses, which can often be crippling and the reason behind reduced access to such services. For example, a single consultation with a leading therapist can be around Rs 1,500 to Rs 2,500 in major cities. Consultations with psychiatrists can be even more expensive. Additional costs of medication also raises monthly expenditure on mental healthcare drastically.

Insurance can also help fight stigma surrounding mental health by normalising the existence of mental health needs and disorders, as seen with physical health. Having such insurance schemes also provides for an effective channel for information dissemination relating to mental healthcare and related regulations in general to a large audience and reduce ignorance.

India is also extremely short on the number of mental health professionals in reference to its estimated needs, especially those that are well trained and verified. According to the Ministry of Health and Family Welfare, there were 3,800 psychiatrists, 898 clinical psychologists, 850 psychiatric social workers and 1,500 psychiatric nurses nationwide, as of December 2015.

Having efficient insurance policies in place by leading providers will make mental healthcare more accessible for many and will drive a market shift towards having more and better trained mental healthcare professionals and education and training programmes. The attached regulatory measures with such policies will help weed quacks out as well.

Dr Avinash De Sousa from the De Sousa Foundation says that the main problems that insurance providers state makes them reticent about providing mental healthcare coverage under insurance policies are:

- Long term treatments
- Varying costs of treatments
- Diagnostic dilemmas with many psychiatric problems
- The lifelong course of many psychiatric disorders

He also says that the costs of psychological treatments like psychotherapy and other psychological treatment show a high variation and the medical cost per month is quite high in case of psychiatric disorders. However, he says that the same is true for other medical problems as well, which are covered by health insurance.

De Sousa feels that covering mental healthcare under insurance would lead to more people seeking help for psychiatric problems, more patients seeking inpatient rehabilitation programs, and that this could also help break the stigma against psychiatric help.

As De Sousa points out, we need to have uniform tiers of treatment costs so that mental healthcare can come under the ambit of insurance. None of the insurance providers The Health Collective reached out to was willing to comment officially on the subject. On condition of anonymity, one representative did tells us that there is apprehension about including mental healthcare in insurance packages, because of a lack of understanding of how mental health diagnostics and costing works.

International best practices
International best practices differ in terms of coverage, extent of coverage and implementation and implementing body.

Canadian healthcare is largely funded by the federal government and thus the provinces and territories are mandated to provide medical facilities for its citizens. While Canadian healthcare systems function well, in terms of mental healthcare, they lack coverage of therapy and majorly psychiatric treatment is covered by insurance. With waiting lists at psychiatrists for patients being extremely long, several patients are unable to get timely help. Several of these patients would benefit greatly from therapy as well, but that is not covered by the medicare policies.

In the United States, the parity law or the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, 2008 or MHPAEA, states that insurers are to treat mental health cover at par with general medical health cover. The introduction of the Patient Protection and Affordable Care Act, 2010, also known as the Affordable Care Act, further led to an amendment in the MHPAEA which extended the provisions of the MHPAEA to individual health coverage, it helped improve the penetration of insurance but treatment received by adults suffering with mental illnesses in America still remains low. Due to varying state laws and implementation, these measures do not always achieve full effect.

The United Kingdom offers quite a comprehensive coverage system in relation to mental health illnesses, including medical, surgical, psychological and psychiatric services, through the National Health Service. Discrimination on the basis of mental health issues while providing insurance services is punishable.

Many countries, like Indonesia, may have systems where while the public insurance would cover physical and mental illnesses, private insurance providers would mostly not cover mental illnesses.

What most countries, including India, need is a comprehensive insurance policy that accounts for mental health across the spectrum as it does for physical illnesses and for governments to build systemic alternate plans for individuals to access good quality affordable mental healthcare.